GOP members are pressuring the secretary to make Sarah Murnaghan, a 10-year-old who has been hospitalized at Children’s Hospital of Philadelphia for three months with end-stage disease, eligible to receive a transplant of adult lungs. Her family has gone very public in seeking an exemption because few pediatric lungs become available and the child is running out of time.

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Sebelius, who would need to intervene in decisions made by a transplant panel, told a House panel Tuesday morning that she has spoken with Sarah’s mother and “can’t imagine anything more difficult.” But she also said it isn’t her job to pick and choose.

“I can’t imagine anything worse than one individual getting to pick who lives and who dies,” she said. Sebelius said putting Sarah next in line would disadvantage other young people who have also been waiting for transplants — three of them at the same hospital.

“Unfortunately, there are about 40 seriously ill Pennsylvanians over the age of 12 also waiting for a lung transplant,” she said.

The Organ Procurement and Transplantation Network sets policies for transplants, working with the nonprofit United Network for Organ Sharing to maintain waiting lists and implement the standards. Under their current policies, those under the age of 12 are considered separately from adults. That means an adult lung will be given to an adult candidate if one exists. Murnaghan is at the top of the list to receive a pediatric lung, but pediatric donors are much more rare.

Sebelius said HHS lawyers disagree with Republicans who insist she can take emergency action. Instead of personally intervening, she has ordered a review of the Organ Procurement and Transplantation Network’s policy.

But Republicans — from Pennsylvania and other states — insist she intervene. “It simply takes your signature,” said Rep. Tom Price (R-Ga.). “A study will take over a year — this young lady will be dead.”

“Why are we going to let a little 10-year-old girl die because she is 10 and not 12,” said Rep. Lou Barletta (R-Pa.). “Please suspend the rules until we look at this policy [that] we all believe is flawed. … We do so much bullcrap around this place and we have the chance to save someone’s life.”

Sen. Pat Toomey and Rep. Patrick Meehan, both Pennsylvania Republicans, wrote to Sebelius on Monday, asking her to reconsider.

“You have the ability and the authority to intervene to allow for Sarah and other children under the age of 12 to become eligible for adult organs,” they wrote.